Provider Demographics
NPI:1275548885
Name:MEDICAL ARTS PRESCRIPTION SHOP
Entity Type:Organization
Organization Name:MEDICAL ARTS PRESCRIPTION SHOP
Other - Org Name:MEDICAL ARTS PRESCRIPTION SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGAZY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:407-422-8104
Mailing Address - Street 1:522 S HUNT CLUB BLVD
Mailing Address - Street 2:STE 350
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4960
Mailing Address - Country:US
Mailing Address - Phone:407-422-8104
Mailing Address - Fax:407-422-8105
Practice Address - Street 1:2021 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3035
Practice Address - Country:US
Practice Address - Phone:407-422-8104
Practice Address - Fax:407-422-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH155153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106172100Medicaid
1018250OtherNCPDP PROVIDER IDENTIFICATION NUMBER